HomeMy WebLinkAboutCLE200800223 Legacy Document 2013-03-18Application for Zpningy Clearance
CLE #
v1tNAN1P
Zoning Clearance = $35
PLEI REVIEW ALL 3 SHEETS
OFFICE USE ONLY 0
' J! Date: `
Receipt # -T2:-7j--7- Staff:
PARCEL INFORMATION /_701- 6MR.&61,2,
Tax Map and Parcel: _ Existing Zoning /
P arcel Owner:
Parcel Address: State Zip z OP � P ,
(include suite or floor)
PRIMARY CONTACT f
Who should we call /write concerning this project ?,0
Address: 3(1 � �sz ua,,rn Lv,_ City State Zip27587
Office Phone: (XZ) 410,3 —S4" Cell # 757 - 241 -0,380 Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change rof`name New business '
Business Name /Type: Att&d
Previous Business on this site 312
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: 1 ,� w.c sM 9
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the b st of my knowledge. I hav read the conditions of approval, understand them, and that I will abide by them.
jand //I
Signature Printed 1AJi�ltZ� U_ l�_✓o �I
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date to '47
Zoning Official Date / y 71
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 04/28/08 Page 2 of 3
Intake to complete the followings
Y/
Is u LI, HI or PDIP zoning? If so, give applicant a Certified
Engin 's Report (CER) packet.
Y/N
Wil re be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or lic water?
If private well, provide He ern form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or public sewer?
Y/N
Will you be putting up a ne,�v sign of any kind? If so, obtain proper
Sign permit. ( I % /�
Permit # l
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # 6 2"-- /'q 9
Zonin2 to com lete the followin :
Reviewer to complete the following:
Square footage of Use:''°
&> / N
Permitted as: Ato 4� I
Under Section:
Supplementary regulations section:
Parking formula: / —, ,
/7
Required spaces:
Y/N J�G�
Items to be verified in the field:
Inspector:
Notes:
Date:
Violations:
/N
so, List: 07 / 95 A/,J /
Proffej's:
YIG
If so, List:
Variance:
Y/O
If so, List:
's:
S /N
If so, List:
Clearances:
SDP's
Revised 04/28/08 Page 3 of 3